Provider Demographics
NPI:1982760583
Name:CARL R. DARNALL ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:CARL R. DARNALL ARMY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MAURA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC, LPC-I, LMFT-A
Authorized Official - Phone:254-285-6296
Mailing Address - Street 1:2608 MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-2773
Mailing Address - Country:US
Mailing Address - Phone:254-699-6832
Mailing Address - Fax:254-287-5246
Practice Address - Street 1:2245 BATALION AVENUE
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-285-6296
Practice Address - Fax:254-287-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10029286500000X
TX61677286500000X
TX201013286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital